Generic Name: Carbamazepine (kar-ba-MAZ-e-peen)

Brand Names: Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol XR®

Classification: Anticonvulsants

Issue Date: 2005

Carbamazepine is in a group of drugs called anticonvulsants. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder and restless leg syndrome (RLS). Carbamazepine may also be used for other purposes not listed in this medication guide.

You should not take this medicine if you have a history of bone marrow suppression, or if you are allergic to an antidepressant such as:

• amitriptyline (Elavil®)
• desipramine (Norpramin®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)

Do not take carbamazepine if you have taken an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• tranylcypromine (Parnate®)
• phenelzine (Nardil®)
• selegiline (Eldepryl®, Emsam®) in the past 14 days

You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Call your doctor at once if you have any new or worsening symptoms such as:

• mood or behavior changes
• depression
• anxiety
• if you feel agitated, hostile
• if you are restless, hyperactive (mentally or physically)
• if you have thoughts about suicide or hurting yourself

There are many other medicines that could cause a drug interaction if you take them together with carbamazepine. Tell your doctor about all the prescription and over-the-counter medications you use.

Do not use carbamazepine without telling your doctor if you are pregnant. It could harm the unborn baby. Ask your doctor about using a non-hormone method of birth control (not birth control pills) to prevent pregnancy while taking carbamazepine.

Do not stop using carbamazepine without first talking to your doctor. You may have increased seizures or unpleasant side effects if you stop using carbamazepine suddenly.

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking the pill would cause too much of the drug to be released at one time.

You may open the extended-release capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow this mixture right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Do not take other liquid medicines at the same time.

The carbamazepine chewable tablet must be chewed before you swallow it.

Carbamazepine can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

Your doctor may recommend having your eyes checked regularly while you are taking this medicine.

It may take up to 4 weeks of using this medicine before your symptoms improve. Do not stop taking the medication even if you feel better. You may have increased seizures or unpleasant side effects if you stop using carbamazepine suddenly.

Call your doctor promptly if this medicine does not seem to be working as well in preventing your seizures.

Carry an ID card or wear a medical alert bracelet stating that you are taking carbamazepine, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking carbamazepine.

Grapefruit and grapefruit juice may interact with carbamazepine and cause unwanted side effects. Do not change the amount of grapefruit products in your diet without first talking to your doctor.

Carbamazepine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It can increase some of the side effects of carbamazepine, and can also increase your risk of seizures.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Carbamazepine can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, other seizure medicines, and medicine for depression or anxiety can add to sleepiness caused by carbamazepine. Tell your doctor if you regularly use any of these other medicines.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Call your doctor at once if you have any new or worsening symptoms such as:

• mood or behavior changes
• depression, anxiety
• if you feel agitated, hostile, restless, hyperactive (mentally or physically)
• have thoughts about suicide or hurting yourself

Call your doctor at once if you have any of these SERIOUS side effects:

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash
• pale skin, easy bruising or bleeding, unusual weakness
• white patches or sores inside your mouth or on your lips
• feeling short of breath, swelling of your ankles or feet
• nausea, stomach pain, loss of appetite, jaundice (yellowing of the skin or eyes)
• urinating less than usual

Less serious side effects may include:

• feeling dizzy, drowsy, or unsteady
• vomiting, diarrhea, constipation, stomach pain
• confusion, headache, blurred vision
• ringing in your ears
• dry mouth, swollen tongue
• joint or muscle pain, leg cramps

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

A large number of over-the-counter and prescription medications may interact with Tegretol in a dangerous way.

Some drugs, such as Biaxin, erythromycin, Darvon or Darvocet DN 100, can make Tegretol much more toxic, with dangerous blood levels building up surprisingly quickly.

Other anticonvulsants interact with Tegretol in complicated ways and may even reduce its effectiveness.

In addition, Tegretol can interfere with the benefits of many other compounds.

Just a few of the many drugs that interact with Tegretol include several different kinds of antidepressant, the blood thinner Coumadin, the ulcer drug Tagamet, the heart and blood pressure pills Cardizem CD, Calan SR and Verelan, and certain antibiotics such as tetracycline, Vibramycin and INH.

Other medications that may cause problems include the asthma drug theophylline, Haldol, Sandimmune, Danocrine and even flu vaccine and activated charcoal.

It's possible that flavonoids found in the herb echinacea affect the enzyme (CYP 3A4) responsible for metabolizing many common drugs. If so, medications such as Tegretol could reach higher levels in the body.

The herb St. Jone's wort might speed elimination of Tegretol from the body, which could reduce its effectiveness.

Psyllium can affect the absorption of Tgretol; if you take it, it is best to do so at least an hour after taking Tegretol.

Do not take any other medications or herbs without first checking with your physician and pharmacist.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Sinemet may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.